Antibiotic Dosing in Renal Replacement Therapy

by Chris Nickson, Last updated December 7, 2012

OVERVIEW

there is little published data to guide dosing of antibiotics in RRT and the critically ill.
therefore we must use first principles and utilize therapeutic drug monitoring if available.

CONSIDERATIONS

Properties of the antibiotic

size of molecule
charge
solubility

Pharmaokinetics of drug

how much will be dialysed
Vd
clearance
protein binding

Pharmacodynamics of drug

what concentrations need to be achieved to be effective
kill characteristics of drug:
– peak dose/concentration dependent (aminoglycosides)
– time above MIC (beta lactams)
– time and concentration dependent (AUC -> quinlones)

Type and settings of RRT

mode: CVVDH, CVVHF, CVVDHF
CVVHD: molecular weight, blood flow rate, dialysate flow rate
CVVHF: ultrafiltrate flow rate
blood flow rate
pre vs post filter dilution

Site of infection/tissue penetration ability of drug

Toxicity of high drug levels

Residual or recovery of intrinsic renal function

RRT prescription compliance

Availability of Theraputic Drug Monitoring

About Chris Nickson

FCICM FACEM BSc(Hons) BHB MBChB MClinEpid(ClinTox) DipPaeds DTM&H GCertClinSim

Chris is an Intensivist at the Alfred ICU in Melbourne and is an Adjunct Clinical Associate Professor at Monash University. He is also the Innovation Lead for the Australian Centre for Health Innovation and the Chair of the Australian and New Zealand Intensive Care Society (ANZICS) Education Committee. He has a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives. After finishing his medical degree at the University of Auckland, he continued post-graduate training in New Zealand as well as Australia's Northern Territory, Perth and Melbourne. He has since completed further training in emergency medicine, clinical toxicology, clinical epidemiology and health professional education. He coordinates the Alfred ICU's education and simulation programmes and runs the unit’s education website, INTENSIVE. He created the 'Critically Ill Airway' course and teaches on numerous courses around the world. He is one of the founders of the FOAM movement (Free Open-Access Medical education) and is co-creator of Lifeinthefastlane.com, the RAGE podcast, the Resuscitology course, and the SMACC conference. His one great achievement is being the father of two amazing children. On Twitter, he is @precordialthump.

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