Inadequate antibiotic dosing in patients receiving sustained low efficiency dialysis

Leigh Anne Keough, Amy Krauss, Joanna Laizure

Research output: Contribution to journalArticle

Abstract

Background Patients requiring SLED are often critically ill and/or hemodynamically unstable, and often need antibiotic therapy for life-threatening infections. Antibiotic dosing recommendations for intermittent hemodialysis and continuous renal replacement therapy are not appropriate for SLED and there is substantial concern for under dosing. Objective To characterize the adequacy of antibiotic dosing during SLED. Setting: Inpatient adult acute care hospital. Methods A retrospective chart review was performed for the period of October 2010 to August 2013 to identify patients who received SLED and at least one of the selected antibiotics: cefepime, daptomycin, piperacillin/tazobactam, meropenem, and vancomycin. Dosing regimens were evaluated each day the patient was receiving one of these antibiotics concurrently with SLED. The administered antibiotic dosing regimens were defined as “adequate” or “inadequate” based on recommendations available in the literature. Main outcome measure The percentage of adequate antibiotic days for each antibiotic. Results Antibiotic regimens were evaluated for a total of 51 patients: 35 (69%) with acute kidney injury, 16 (31%) with end-stage renal disease, mean SLED duration 9.3 ± 1.7 h. The total percent of adequate antibiotic days were: vancomycin 86%, cefepime 62%, daptomycin 58%, meropenem 35%, and piperacillin/tazobactam 20%. Under dosing accounted for 63% of the days antibiotic dosing was considered inadequate. Conclusion: Antibiotic dosing was frequently inadequate, especially for antibiotics requiring more frequent dosing, suggesting a high potential for subtherapeutic levels during the majority of time critically ill patients are requiring SLED.

Original languageEnglish (US)
Pages (from-to)1250-1256
Number of pages7
JournalInternational Journal of Clinical Pharmacy
Volume40
Issue number5
DOIs
StatePublished - Oct 1 2018

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Dialysis
Anti-Bacterial Agents
meropenem
Daptomycin
Vancomycin
Critical Illness
Renal Replacement Therapy
Acute Kidney Injury
Chronic Kidney Failure
Renal Dialysis
Inpatients

All Science Journal Classification (ASJC) codes

  • Pharmacy
  • Toxicology
  • Pharmacology
  • Pharmaceutical Science
  • Pharmacology (medical)

Cite this

Inadequate antibiotic dosing in patients receiving sustained low efficiency dialysis. / Keough, Leigh Anne; Krauss, Amy; Laizure, Joanna.

In: International Journal of Clinical Pharmacy, Vol. 40, No. 5, 01.10.2018, p. 1250-1256.

Research output: Contribution to journalArticle

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abstract = "Background Patients requiring SLED are often critically ill and/or hemodynamically unstable, and often need antibiotic therapy for life-threatening infections. Antibiotic dosing recommendations for intermittent hemodialysis and continuous renal replacement therapy are not appropriate for SLED and there is substantial concern for under dosing. Objective To characterize the adequacy of antibiotic dosing during SLED. Setting: Inpatient adult acute care hospital. Methods A retrospective chart review was performed for the period of October 2010 to August 2013 to identify patients who received SLED and at least one of the selected antibiotics: cefepime, daptomycin, piperacillin/tazobactam, meropenem, and vancomycin. Dosing regimens were evaluated each day the patient was receiving one of these antibiotics concurrently with SLED. The administered antibiotic dosing regimens were defined as “adequate” or “inadequate” based on recommendations available in the literature. Main outcome measure The percentage of adequate antibiotic days for each antibiotic. Results Antibiotic regimens were evaluated for a total of 51 patients: 35 (69{\%}) with acute kidney injury, 16 (31{\%}) with end-stage renal disease, mean SLED duration 9.3 ± 1.7 h. The total percent of adequate antibiotic days were: vancomycin 86{\%}, cefepime 62{\%}, daptomycin 58{\%}, meropenem 35{\%}, and piperacillin/tazobactam 20{\%}. Under dosing accounted for 63{\%} of the days antibiotic dosing was considered inadequate. Conclusion: Antibiotic dosing was frequently inadequate, especially for antibiotics requiring more frequent dosing, suggesting a high potential for subtherapeutic levels during the majority of time critically ill patients are requiring SLED.",
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