Active Ingredients: Ciprofloxacin
Three studies determined ceftazidime doses using newer CRRT modalities. Ceftazidime 1 g q 12 h is appropriate during CVVH.
Studies have not been performed with cefazolin, cefotaxime, or aztreonam during CRRT. However, their pharmacokinetic and molecular properties are similar enough such that extrapolations are appropriate. Fluoroquinolones Few antibiotic classes have more data supporting the influence of pharmacodynamics on clinical outcomes than fluoroquinolones.
The additional influence of CRRT makes dosing even more complex.
Many studies have documented minimal effects of CRRT on fluoroquinolone elimination. A ciprofloxacin dosage of 400 mg q. Levofloxacin is excreted largely unchanged in the urine, and significant dosage adjustments are necessary for patients with renal failure.
Intermittent hemodialysis does not effectively remove levofloxacin, and therefore, supplemental doses are not required after hemodialysis.
Malone et al. These data, as well as known pharmacokinetics data, indicate no need to adjust the moxifloxacin dosage for patients receiving CRRT.
Colistin Polymyxins have recently reemerged as therapeutic options for multidrug-resistant gram-negative organisms, such as P. Colistimethate sodium is the parenteral formulation of colistin and is the product for which dosing recommendations are made.
Colistin is a large cationic molecule with a molecular weight of 1750 D, and it is tightly bound to membrane lipids of cells in tissues throughout the body. These 2 properties suggest that the impact of CRRT on colistin elimination is minimal.
Colistin dosing should be based on the following 2 patient-specific factors: underlying renal function and ideal body weight. No clinical data exist on colistin dosing for patients receiving CRRT.
On the basis of clinical experience and the pharmacokinetic properties of colistin, we recommend using colistin at a dosage of 2. Aminoglycosides Two pharmacokinetic parameters are essential predictors of aminoglycoside dosing.
The volume of distribution can be used to predict the drug dose, and the elimination rate can be used to predict the required dosing interval. However, CRRT offers some "control" in such a dynamic state, and if the variables of CRRT are held constant, aminoglycoside elimination is likely to be similarly constant.
This equates to an aminoglycoside half-life of 6—20 h.
Indeed, most patients undergoing CRRT will require an interval of 24, 36, or 48 h. The target peak concentration can also predict the dosing interval.
Therefore, the higher the target peak concentration, the longer the required dosing interval. These principles are reflected in the dosing recommendations in table 3.
Doses used in intermittent hemodialysis cannot be directly applied to these patients, and antibiotic pharmacokinetics are different than those in patients with normal renal function.
Search Menu Abstract Continuous renal replacement therapy CRRT is now commonly used as a means of support for critically ill patients with renal failure.