Antimicrobial Doses in Continuous Renal Replacement Therapy: A Comparison of Dosing Strategies

Purpose. Drug dose recommendations are not well defined in patients undergoing continuous renal replacement therapy (CRRT) due to limited published data. Several guidelines and pharmacokinetic equations have been proposed as tools for CRRT drug dosing. Dose recommendations derived from these methods...

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Main Authors: Anna P. Kempke, Abbie S. Leino, Farzad Daneshvar, John Andrew Lee, Bruce A. Mueller
Format: Article
Language:English
Published: Wiley 2016-01-01
Series:Critical Care Research and Practice
Online Access:http://dx.doi.org/10.1155/2016/3235765
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author Anna P. Kempke
Abbie S. Leino
Farzad Daneshvar
John Andrew Lee
Bruce A. Mueller
author_facet Anna P. Kempke
Abbie S. Leino
Farzad Daneshvar
John Andrew Lee
Bruce A. Mueller
author_sort Anna P. Kempke
collection DOAJ
description Purpose. Drug dose recommendations are not well defined in patients undergoing continuous renal replacement therapy (CRRT) due to limited published data. Several guidelines and pharmacokinetic equations have been proposed as tools for CRRT drug dosing. Dose recommendations derived from these methods have yet to be compared or prospectively evaluated. Methods. A literature search of PubMed, Micromedex, and Embase was conducted for 40 drugs commonly used in the ICU to gather pharmacokinetic data acquired from patients with acute and chronic kidney disease as well as healthy volunteers. These data and that obtained from drug package inserts were gathered for use in three published CRRT drug dosing equations. Doses calculated for a model patient using each method were compared to doses suggested in a commonly used dosing text. Results. Full pharmacokinetic data was available for 18, 31, and 40 agents using acute kidney injury, end stage renal disease, and normal patient data, respectively. On average, calculated doses differed by 30% or more from the doses recommended by the renal dosing text for >50% of the medications. Conclusion. Wide variability in dose recommendations for patients undergoing CRRT exists when these equations are used. Alternate, validated dosing methods need to be developed for this at-risk patient population.
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spelling doaj-art-4ad0fdd32a4742baa6b7458a07389efc2025-02-03T06:11:06ZengWileyCritical Care Research and Practice2090-13052090-13132016-01-01201610.1155/2016/32357653235765Antimicrobial Doses in Continuous Renal Replacement Therapy: A Comparison of Dosing StrategiesAnna P. Kempke0Abbie S. Leino1Farzad Daneshvar2John Andrew Lee3Bruce A. Mueller4Clinical Pharmacy Department, University of Michigan College of Pharmacy, Ann Arbor, MI 48109, USAClinical Pharmacy Department, University of Michigan College of Pharmacy, Ann Arbor, MI 48109, USAClinical Pharmacy Department, University of Michigan College of Pharmacy, Ann Arbor, MI 48109, USAClinical Pharmacy Department, University of Michigan College of Pharmacy, Ann Arbor, MI 48109, USAClinical Pharmacy Department, University of Michigan College of Pharmacy, Ann Arbor, MI 48109, USAPurpose. Drug dose recommendations are not well defined in patients undergoing continuous renal replacement therapy (CRRT) due to limited published data. Several guidelines and pharmacokinetic equations have been proposed as tools for CRRT drug dosing. Dose recommendations derived from these methods have yet to be compared or prospectively evaluated. Methods. A literature search of PubMed, Micromedex, and Embase was conducted for 40 drugs commonly used in the ICU to gather pharmacokinetic data acquired from patients with acute and chronic kidney disease as well as healthy volunteers. These data and that obtained from drug package inserts were gathered for use in three published CRRT drug dosing equations. Doses calculated for a model patient using each method were compared to doses suggested in a commonly used dosing text. Results. Full pharmacokinetic data was available for 18, 31, and 40 agents using acute kidney injury, end stage renal disease, and normal patient data, respectively. On average, calculated doses differed by 30% or more from the doses recommended by the renal dosing text for >50% of the medications. Conclusion. Wide variability in dose recommendations for patients undergoing CRRT exists when these equations are used. Alternate, validated dosing methods need to be developed for this at-risk patient population.http://dx.doi.org/10.1155/2016/3235765
spellingShingle Anna P. Kempke
Abbie S. Leino
Farzad Daneshvar
John Andrew Lee
Bruce A. Mueller
Antimicrobial Doses in Continuous Renal Replacement Therapy: A Comparison of Dosing Strategies
Critical Care Research and Practice
title Antimicrobial Doses in Continuous Renal Replacement Therapy: A Comparison of Dosing Strategies
title_full Antimicrobial Doses in Continuous Renal Replacement Therapy: A Comparison of Dosing Strategies
title_fullStr Antimicrobial Doses in Continuous Renal Replacement Therapy: A Comparison of Dosing Strategies
title_full_unstemmed Antimicrobial Doses in Continuous Renal Replacement Therapy: A Comparison of Dosing Strategies
title_short Antimicrobial Doses in Continuous Renal Replacement Therapy: A Comparison of Dosing Strategies
title_sort antimicrobial doses in continuous renal replacement therapy a comparison of dosing strategies
url http://dx.doi.org/10.1155/2016/3235765
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