Antimicrobial safety considerations in critically ill patients: part I: focused on acute kidney injury

ABSTRACT

Introduction

Antibiotic prescription is a challenging issue in critical care settings. Different pharmacokinetic and pharmacodynamic properties, polypharmacy, drug interactions, and high incidence of multidrug-resistant microorganisms in this population can influence the selection, safety, and efficacy of prescribed antibiotics.

Areas covered

In the current article, we searched PubMed, Scopus, and Google Scholar for estimating renal function in acute kidney injury, nephrotoxicity of commonly used antibiotics, and nephrotoxin stewardship in intensive care units.

Expert opinion

Early estimation of kidney function with an accurate method may be helpful to optimize antimicrobial treatment in critically ill patients. Different antibiotic dosing regimens may be required for patients with acute kidney injury. In many low-resource settings, therapeutic drug monitoring is not available for antibiotics. Acute kidney injury may influence treatment effectiveness and patient outcome.

KEYWORDS:

• Antibiotics
• fluid overload
• nephrotoxins stewardship
• toxicity

Article highlights

• Appropriate antimicrobial regimen is a challenging issue in the critical care setting.

• Augmented renal clearance (ARC), acute kidney injury (AKI), hepatic failure, positive fluid balance, and low albumin levels may affect the best antibiotic dosing regimens in critical care units.

• Measurement of 1-8-hour urine CrCl may be a practical method for medication dose adjustment in ICU patients with unstable renal function.

• Before selecting combination therapy, the nephrotoxicity of combination regimens should be considered by clinicians.

Disclosure statement

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

FundingThis paper was not funded.