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The following is a summary of “Antibiotic dosing recommendations in critically ill patients receiving new innovative kidney replacement therapy,” published in the February 2024 issue of Nephrology by Lewis et al.
The Tablo Hemodialysis System, a novel kidney replacement therapy (KRT), offers diverse options for critically ill patients with acute kidney injury, potentially affecting antibiotic clearance differently than conventional KRT due to varying effluent rates and treatment schedules.
Researchers conducted a retrospective Monte Carlo Simulation (MCS) study to determine antibiotic doses expected to achieve therapeutic goals across various combinations of KRT.
They utilized published body weights and pharmacokinetic parameter estimates to forecast drug exposure for cefepime, ceftazidime, imipenem, meropenem, and piperacillin/tazobactam in virtual critically ill patients undergoing five different KRT regimens. Efficacy targets were defined based on standard free ?-lactam plasma concentration-time above minimum inhibitory concentration (MIC) thresholds (40–60% fT>MIC and 40–60% fT>MICx4). MCS was employed to evaluate the probability of target attainment (PTA) and the risk of toxicity associated with various antibiotic dosing strategies. Optimal dosing strategies were determined as the smallest doses achieving PTA ? 90% over a 1-week treatment duration.
The results showed that MCS identified ?-lactam doses that achieved ?90% PTA across all KRT options. The characteristics of KRT influenced antibiotic dosing. Cefepime and piperacillin/tazobactam regimens designed to meet stringent efficacy targets were more likely to surpass toxicity thresholds.
Investigators concluded that while new KRT systems impact ?-lactam antibiotic dosing, effective therapeutic regimens can be established through further clinical evaluation.
Source: bmcnephrol.biomedcentral.com/articles/10.1186/s12882-024-03469-2
The post Optimal Antibiotic Dosing Strategies for Critically Ill Patients Undergoing Advanced KRT first appeared on Physician’s Weekly.
