OPTIMIZING DRUG DOSING IN CRITICALLY ILL PATIENTS WITH AUGMENTED RENAL CLEARANCE: A COMPREHENSIVE REVIEW AND META-ANALYSIS

ANJALI KUMBHAR; MIHIR CHACHAR; TALLINI LOKHANDE; ROHINI CHAVAN; DHANRAJ SHINDE

doi:10.22159/ijpps.2024v16i10.52092

Authors

ANJALI KUMBHAR Department of Clinical Pharmacy, Modern College of Pharmacy, Nigdi, Pune, India https://orcid.org/0009-0003-5171-2999
MIHIR CHACHAR Department of Clinical Pharmacy, Modern College of Pharmacy, Nigdi, Pune, India https://orcid.org/0009-0003-4926-4541
TALLINI LOKHANDE Department of Clinical Pharmacy, Modern College of Pharmacy, Nigdi, Pune, India https://orcid.org/0009-0004-5410-8241
ROHINI CHAVAN Department of Clinical Pharmacy, Modern College of Pharmacy, Nigdi, Pune, India https://orcid.org/0009-0007-4249-2962
DHANRAJ SHINDE Intensive and Pediatric Care Clinical Pharmacist, Deenanath Mangeshkar Hospital and Research Center, Pune, India https://orcid.org/0009-0002-3421-8772

DOI:

https://doi.org/10.22159/ijpps.2024v16i10.52092

Keywords:

Augmented renal clearance, Critically ill patients, Antibiotic dose adjustments, Treatment failure, Increased dose, eGFR, Creatinine clearance

Abstract

Renal clearance plays a pivotal role in eliminating most administered drugs, particularly antibiotics, which is crucial for achieving therapeutic goals by maintaining plasma concentrations within the therapeutic window. Various pre-existing conditions such as renal replacement therapies, kidney or liver impairment, and enhanced excretory organ function can disrupt drug concentrations, leading to treatment failure. Augmented Renal Clearance (ARC) exacerbates this by causing rapid drug elimination, notably in critically ill patients. Consequently, careful monitoring and adjustment of drug dosages tailored to individual patient conditions and comorbidities are imperative to prevent sub-therapeutic outcomes or treatment failures. Our review highlights the necessity of dosage modifications informed by current research to optimize therapeutic outcomes in such cases. We provide a comprehensive table detailing effective antibiotics and their adjustments for ARC.

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