Optimization of β-Lactams dosing regimens in critically ill patients with augmented renal clearance

Authors

  • Cédric Carrié Service de Réanimation Chirurgicale et Traumatologique, CHU Pellegrin, 33000 Bordeaux, France https://orcid.org/0000-0003-2492-0349
  • Noémie Sauvage Service de Réanimation Chirurgicale et Traumatologique, CHU Pellegrin, 33000 Bordeaux, France
  • Matthieu Biais Service de Neuro Anesthésie et Réanimation, CHU Pellegrin, 33000 Bordeaux, France

DOI:

https://doi.org/10.37051/mir-00059

Keywords:

Augmented renal clearance, β-lactams, pharmacokinetic, therapeutic drug monitoring, intensive care

Abstract

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.

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Published

2021-03-18

How to Cite

Carrié, C., Sauvage, N., & Biais, M. (2021). Optimization of β-Lactams dosing regimens in critically ill patients with augmented renal clearance. Médecine Intensive Réanimation. https://doi.org/10.37051/mir-00059

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