Prescribing antibiotic treatment in patients on renal replacement therapy

Czech version

Authors: O. Zakiyanov; J. Vachek; V. Tesař
Authors‘ workplace: Klinika nefrologie 1. LF UK a VFN v Praze
Published in: Kardiol Rev Int Med 2015, 17(4): 342-344
Category: Cardiology Review

Overview

When renal function is impaired, any drug which is excreted by the kidney will be retained in the body. Continued administration of certain drugs may result in abnormally high blood levels and dangerous side-effects. However, specifically in the case of antibiotics, we must also consider the risk associated with doses that are too low, which may be more threatening for patients suffering from severe infections than the risk of adverse effects. When managing antibiotic treatment, we must take into account certain factors about the patient (e. g. severity of the infection, status of the immune system), the impact of the renal replacement therapy (type of dialysis and dialysis membrane, duration and frequency of dialysis sessions), and the characteristics of the drug (dialysability, drug lipophilicity, nephrotoxicity, organ toxicity). Determining the risk-benefit ratio always compels an individualised approach. Helpful tools include peak and trough drug levels measurement (Therapeutic Drug Monitoring – TDM) and co-operation between the attending physician and the nephrologist, clinical pharmacist, microbiologist and possibly other specialists.

Keywords:
antibiotics – chronic kidney disease – haemodialysis – peritoneal dialysis

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