Individualized antibiotic dosage regimens for patients with augmented renal clearance

Frontiers in Pharmacology

Pharmacology

Hai-Hui Zhuang¹  Yi-Wen Xiao¹  Yi-Ping Liu¹  Wei-Xin Xu¹  Xin-Qi Teng¹  A-Xi Shi²  Jian Qu³  Qiang Qu⁴ 

[1] Department of Pharmacy, The Second Xiangya Hospital, Institute of Clinical Pharmacy, Central South University, Changsha, China;Department of Pharmacy, The Second Xiangya Hospital, Institute of Clinical Pharmacy, Central South University, Changsha, China;Department of Pharmacy, The First Hospital of Lanzhou University, Lanzhou, China;Department of Pharmacy, The Second Xiangya Hospital, Institute of Clinical Pharmacy, Central South University, Changsha, China;Hunan Key Laboratory of the Research and Development of Novel Pharmaceutical Preparations, Changsha Medical University, Changsha, China;Department of Pharmacy, Xiangya Hospital, Central South University, Changsha, China;National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China;Hunan Key Laboratory of the Research and Development of Novel Pharmaceutical Preparations, Changsha Medical University, Changsha, China;

关键词: augmented renal clearance;    antibiotic;    pharmacokinetics;    pharmacodynamics;    individualized;   

DOI  :  10.3389/fphar.2023.1137975

 received in 2023-01-05, accepted in 2023-07-12,  发布年份 2023

来源: Frontiers

【 摘 要 】

Objectives: Augmented renal clearance (ARC) is a state of enhanced renal function commonly observed in 30%–65% of critically ill patients despite normal serum creatinine levels. Using unadjusted standard dosing regimens of renally eliminated drugs in ARC patients often leads to subtherapeutic concentrations, poor clinical outcomes, and the emergence of multidrug-resistant bacteria. We summarized pharmaceutical, pharmacokinetic, and pharmacodynamic research on the definition, underlying mechanisms, and risk factors of ARC to guide individualized dosing of antibiotics and various strategies for optimizing outcomes.Methods: We searched for articles between 2010 and 2022 in the MEDLINE database about ARC patients and antibiotics and further provided individualized antibiotic dosage regimens for patients with ARC.Results: 25 antibiotic dosage regimens for patients with ARC and various strategies for optimization of outcomes, such as extended infusion time, continuous infusion, increased dosage, and combination regimens, were summarized according to previous research.Conclusion: ARC patients, especially critically ill patients, need to make individualized adjustments to antibiotics, including dose, frequency, and method of administration. Further comprehensive research is required to determine ARC staging, expand the range of recommended antibiotics, and establish individualized dosing guidelines for ARC patients.

【 授权许可】

Unknown   
Copyright © 2023 Shi, Qu, Zhuang, Teng, Xu, Liu, Xiao and Qu.