Optimization of β-Lactams dosing regimens in critically ill patients with augmented renal clearance
Keywords:Augmented renal clearance, β-lactams, pharmacokinetic, therapeutic drug monitoring, intensive care
Optimizing β-Lactam antimicrobial therapy still represents a complex challenge, given the wide and unpredictable variability of antibiotic concentrations in critically ill patients. À “one dose fits all” approach could especially be problematic in patients with augmented renal clearance (ARC), potentially leading to subtherapeutic drug exposure and higher rates of clinical failure when conventional dosing regimens are used. For some β-lactams, several studies previously suggested that higher than licensed dosing regimens would be necessary to improve empirical pharmacokinetic/pharmacodynamic (PK/PD) target attainment rates in patients with ARC. In patients with severe infections, optimization of β-Lactams dosing regimens according to the creatinine clearance (CLCR) monitoring may be safe and effective to improve the rates of therapeutic success without increased risk of toxicity. This strategy doesn’t preclude the need of therapeutic drug monitoring, especially when targeting less susceptible pathogens or surgical infections with limited penetration of antimicrobial agents.