PMID- 22843155
OWN - NLM
STAT- MEDLINE
DCOM- 20121001
LR  - 20151119
IS  - 0393-5590 (Print)
IS  - 0393-5590 (Linking)
VI  - 29
IP  - 4
DP  - 2012 Jul-Aug
TI  - [Pharmacokinetics of antibiotics in continuous renal replacement therapies 
      (CRRT)].
PG  - 425-44
AB  - In the critically ill patient, acute kidney injury (AKI) is frequently associated 
      with infective complications requiring appropriate antimicrobial treatment. AKI 
      and multiple organ dysfunction syndrome can affect the pharmacokinetic parameters 
      of many drugs. Furthermore, the start of renal replacement therapy (RRT) is an 
      additional variable to be taken into consideration to avoid inappropriate 
      antimicrobial therapy. Continuous renal replacement therapies (CRRT) are widely 
      adopted in the intensive care unit (ICU) and antibiotics that are significantly 
      eliminated by the kidney are likely to be removed during RRT. Generally, 
      drug-dosing adjustments are required if the extracorporeal clearance accounts for 
      more than 25-30% of the total body clearance. The molecular weight cutoffs of the 
      more widely used membranes are much higher than the molecular weight of most 
      drugs. Therefore, molecular size will not be a limitation for the removal of the 
      unbound fraction of the antibiotics most commonly used in ICU patients. However, 
      CRRTs are still not standardized and the impact of RRT on plasma drug 
      concentrations can be substantially different depending on the CRRT modality 
      (diffusive, convective or both), membrane characteristics and delivered dialysis 
      dose. In any case, drug-dosing adjustments should be based on the knowledge of 
      the pharmacokinetic and pharmacodynamic properties of the different classes of 
      antimicrobials, taking into account that high extracorporeal clearances could 
      lead to drug underexposure in clinical conditions where appropriate antibiotic 
      treatment is essential.
FAU - Morabito, Santo
AU  - Morabito S
AD  - Dipartimento Nefrologia e Urologia, Umberto I, Policlinico di Roma, ''Sapienza'', 
      Universita' di Roma, Italy. santo.morabito@uniromal.it
FAU - Pistolesi, Valentina
AU  - Pistolesi V
FAU - Maggiore, Umberto
AU  - Maggiore U
FAU - Fiaccadori, Enrico
AU  - Fiaccadori E
FAU - Pierucci, Alessandro
AU  - Pierucci A
LA  - ita
PT  - English Abstract
PT  - Journal Article
TT  - Farmacocinetica degli antibiotici nelle terapie sostitutive renali continue 
      (CRRT).
PL  - Italy
TA  - G Ital Nefrol
JT  - Giornale italiano di nefrologia : organo ufficiale della Societa italiana di 
      nefrologia
JID - 9426434
RN  - 0 (Anti-Bacterial Agents)
SB  - IM
MH  - Acute Kidney Injury/complications/therapy
MH  - Anti-Bacterial Agents/administration & dosage/*pharmacokinetics
MH  - Bacterial Infections/drug therapy/etiology
MH  - Humans
MH  - *Renal Replacement Therapy
MH  - Surveys and Questionnaires
EDAT- 2012/07/31 06:00
MHDA- 2012/10/02 06:00
CRDT- 2012/07/31 06:00
PHST- 2012/07/31 06:00 [entrez]
PHST- 2012/07/31 06:00 [pubmed]
PHST- 2012/10/02 06:00 [medline]
PST - ppublish
SO  - G Ital Nefrol. 2012 Jul-Aug;29(4):425-44.