Dosing During Dialysis: Know Your Antibiotics!

Antibiotic dosing matters….especially while your patient is on dialysis!

  • Inappropriate antimicrobial dosing is associated with higher mortality and the addition of continuous renal replacement therapy (CRRT) complicates matters further.
  • The addition of CRRT requires further dosage adjustments to account for additional volume and interaction with the dialysis filter; however, specific medication data to make these adjustments is limited.
  • After utilizing your local pharmacist and discussing dosing with them, here are some questions to consider while your patient is receiving CRRT:
    • What is the pharmacologic properties of the medication and how they will alter the interaction with the CRRT
    • Is the medication renally or hepatically cleared?
    • Is the medication highly protein bound or free and active and is the medication hydrophilic or lipophilic?
    • What is the molecular size of the medication (i.e., how readily dialysable it will be)?
    • Is the antimicrobial time dependent (requiring an adequate concentration over the dosing period) or concentration dependent (requiring an adequate peak level) in its action?
    • Can you send a drug level to assess the dosing strategy (e.g., gentamicin, vancomycin, etc.)?





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