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

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