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Therapeutic Drug Monitoring of Antibiotic Drugs in Patients Receiving Continuous Renal Replacement Therapy or Intermittent Hemodialysis: A Critical Review
- Source :
- Therapeutic Drug Monitoring. 44:86-102
- Publication Year :
- 2022
- Publisher :
- Ovid Technologies (Wolters Kluwer Health), 2022.
-
Abstract
- Purpose Antibiotics are frequently used in patients receiving intermittent or continuous renal replacement therapy (RRT). RRT may alter the pharmacokinetics (PK), as well as the ability to achieve PK/pharmacodynamic (PD) targets. Therapeutic drug monitoring (TDM) could help evaluatedrug exposure and guide antibiotic dosage adjustment. The present review describes recent TDM data on antibiotic exposure and PK/PD target attainment in patients receiving intermittent or continuous RRT, proposing practical guidelines for performing TDM. Methods Studies on antibiotic TDM performed in patients receiving intermittent or continuous RRT published between 2000 and 2020 were searched and assessed. The authors focused on studies that reported data on PK/PD target attainment. TDM recommendations were based on clinically relevant PK/PD relationships and previously published guidelines. Results In total, 2383 reports were retrieved. After excluding non-relevant publications, 139 articles were selected. Overall, 107 studies reported PK/PD target attainment for 24 agents. Data were available for various intermittent and continuous RRT techniques. The study design, TDM practice, and definition of PK/PD targets were inconsistent across studies. Drug exposure and target attainment rates were highly variable. TDM appears necessary to control drug exposure in patients receiving intermittent and continuous RRT techniques, especially for antibiotics with narrow therapeutic margins and in critically ill patients. Practical recommendations can provide insights on relevant PK/PD targets, sampling, and timing of TDM for various antibiotic classes. Conclusion Highly variable antibiotic exposure and target attainment have been reported in patients receiving intermittent or continuous RRT. TDM for aminoglycosides, beta-lactams, glycopeptides, linezolid, and colistin is recommended in patients receiving RRT and suggested for daptomycin, fluoroquinolones, and tigecycline in critically ill patients on RRT.
- Subjects :
- Drug
medicine.medical_specialty
Continuous Renal Replacement Therapy
medicine.drug_class
Critical Illness
media_common.quotation_subject
medicine.medical_treatment
Antibiotics
Tigecycline
beta-Lactams
urologic and male genital diseases
chemistry.chemical_compound
Pharmacokinetics
Renal Dialysis
medicine
Humans
Pharmacology (medical)
Renal replacement therapy
Intensive care medicine
media_common
Pharmacology
medicine.diagnostic_test
business.industry
Anti-Bacterial Agents
Renal Replacement Therapy
chemistry
Therapeutic drug monitoring
Pharmacodynamics
Linezolid
Drug Monitoring
business
medicine.drug
Subjects
Details
- ISSN :
- 01634356
- Volume :
- 44
- Database :
- OpenAIRE
- Journal :
- Therapeutic Drug Monitoring
- Accession number :
- edsair.doi.dedup.....9a6a9772c8a2c91ae76b570401248aba