Expert opinion on drug metabolism & toxicology
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Expert Opin Drug Metab Toxicol · May 2021
ReviewThe impact of continuous renal replacement therapy on antibiotic pharmacokinetics in critically ill patients.
Introduction: Mortality due to severe infections in critically ill patients undergoing continuous renal replacement therapy (CRRT) remains high. Nevertheless, rapid administration of adequate antibiotic therapy can improve survival. Delivering optimized antibiotic therapy can be a challenge, as standard drug regimens often result in insufficient or excessive serum concentrations due to significant changes in the volume of distribution and/or drug clearance in these patients. ⋯ We have provided explanations for the changes in the PKs of antibiotics observed and suggestions to optimize dosage regimens in these patients. Expert opinion: Despite considerable efforts to identify optimal antibiotic dosage regimens for critically ill patients receiving CRRT, adequate target achievement remains too low for hydrophilic antibiotics in many patients. Whenever possible, individualized therapy based on results from therapeutic drug monitoring must be given to avoid undertreatment or toxicity.