Antibiotic Dosing During Renal Failure

Antibiotic Dosing During Renal Failure February 1, 2010 Sarah Nelson, Pharm.D. Critical Care Pharmacy Resident

Objectives ,[object Object],[object Object],[object Object],[object Object]

Kidney Disease ,[object Object],[object Object],[object Object],Wargo et al. Comparison of the Modification of Diet in Renal Disease and Cockroft-Gault Equations for Antimicrobial Dosage Adjustments. The Annals of Pharmacotherapy . 2006;40:1248-1253

Importance of Renal Function ,[object Object],[object Object],[object Object],[object Object],[object Object],Livornese et al. Use of antibacterial agents in renal failure. Infect Dis Clin N Am. 2004;18:551-579

Importance of Renal Function ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Renal Excretion http://www.unckidneycenter.org/images/glomerulus.jpg

Risk Factors/Markers of Renal Impairment ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Calculating GFR ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Wargo et al. Comparison of the Modification of Diet in Renal Disease and Cockroft-Gault Equations for Antimicrobial Dosage Adjustments. The Annals of Pharmacotherapy . 2006;40:1248-1253

Calculating GFR ,[object Object],[object Object],[object Object],[object Object],[object Object],Moranville, M et al. Implications of using modification of diet in renal disease versus Cockroft-Gault equations for renal dosing adjustments. Am J Health-Syst Pharm. 2009;66:154-161

MDRD ,[object Object],[object Object],[object Object],[object Object],[object Object],Moranville, M et al. Implications of using modification of diet in renal disease versus Cockroft-Gault equations for renal dosing adjustments. Am J Health-Syst Pharm. 2009;66:154-161

MDRD ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Golik et al. Comparison of Dosing Recommendations for Antimicrobial Drugs Based on Two Methods for Assessing Kidney Function: Cockroft-Gault and Modification of Diet in Renal Disease. Pharmacotherapy. 2008;28(9):1125-1132

Cockroft-Gault ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Moranville, M et al. Implications of using modification of diet in renal disease versus Cockroft-Gault equations for renal dosing adjustments. Am J Health-Syst Pharm. 2009;66:154-161

Cockroft-Gault ,[object Object],[object Object],[object Object],[object Object],[object Object],Golik et al. Comparison of Dosing Recommendations for Antimicrobial Drugs Based on Two Methods for Assessing Kidney Function: Cockroft-Gault and Modification of Diet in Renal Disease. Pharmacotherapy. 2008;28(9):1125-1132

Weight Calculations ,[object Object],[object Object],[object Object]

Cockroft-Gault ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

TIME OUT!! ,[object Object],[object Object],[object Object],[object Object],[object Object],SCr Weight Height 1.9 mg/dL 57 kg 5'3"

Pause for the Cause! ,[object Object],[object Object],[object Object],[object Object],[object Object],SCr Weight Height 2.85 mg/dL 86 kg 5‘10"

Which should I use? ,[object Object],[object Object],[object Object],[object Object],Wargo et al. Comparison of the Modification of Diet in Renal Disease and Cockroft-Gault Equations for Antimicrobial Dosage Adjustments. The Annals of Pharmacotherapy . 2006;40:1248-1253

Beware! ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Dosing in Renal Failure ,[object Object],[object Object],[object Object],[object Object]

Factors to Consider when Adjusting Dose ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Stages of Kidney Disease Adapted from the National Kidney Foundation Stage Description GFR (mL/min/1.73 m 2 ) 1 Kidney damage with normal GFR ≥ 90 2 Kidney damage with mild ↓ in GFR 60-89 3 Moderate ↓ GFR 30-59 4 Severe ↓ GFR 15-29 5 Kidney Failure <15 (or dialysis)

Dialysis ,[object Object],[object Object],[object Object],[object Object],[object Object],Rowland, Malcolm (1995). Clinical Pharmacokinetics: Concepts and Applications . 3 rd Ed. USA: Lippincott, Williams, and Wilkins. 448-453.

Continuous Dialysis ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Trotman et al. Antibiotic Dosing in Critically Ill Adult Patients Receiving Continuous Renal Replacement Therapy. CID . 2005;41:1159-1166

Adjusting Antimicrobials During Dialysis ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

References ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Example #1: Fluconazole ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Example #1: Fluconazole ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Example #1: Fluconazole ,[object Object],[object Object]

Example #2: Pip/Tazo ,[object Object],[object Object],1/19 1/20 1/22 1/23 Scr 0.9mg/dL 1.1mg/dL 1.24mg/dL 1.45mg/dL Weight Height UO 87 kg 5’4” 44 mL/hour

Example #2: Pip/Tazo ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Example #2: Pip/Tazo ,[object Object],[object Object],[object Object]

Example #3: Levofloxacin ,[object Object],[object Object],[object Object],[object Object],[object Object]

Example #3: Levofloxacin ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Example #3: Levofloxacin ,[object Object]

Conclusions ,[object Object],[object Object],[object Object],[object Object]

Antibiotic Dosing During Renal Failure

Recommended

Recommended

More Related Content

What's hot

What's hot (20)

Viewers also liked

Viewers also liked (20)

Similar to Antibiotic Dosing During Renal Failure

Similar to Antibiotic Dosing During Renal Failure (20)

Antibiotic Dosing During Renal Failure