Antibiotic dosing regimens for septic patients receiving continuous venovenous haemofiltration: do current studies supply sufficient data?

Introduction

The aim of this study was to establish the minimum dataset that needs to be specified when presenting pharmacokinetic data for critically ill patients with acute renal failure, and to review the current literature to establish whether this minimum dataset is indeed reported. Antibiotic dosing for septic patients with acute renal failure receiving continuous renal replacement therapy is complicated, and failure to correctly dose may result in either drug toxicity, or treatment failure and development of resistance [1].

Methods

A dataset was established of the minimal number of parameters that need be reported when calculating a drug-dosing regimen. Patient demographics and markers of severity were added to allow for patient population comparisons. A Medline search was performed of the relevant literature, producing 76 studies from which completeness of the dataset was examined.

Results

None of the studies analysed presented the full dataset that we established as necessary (Figure 1). Of concern, basic pharmacokinetic parameters such as the volume of distribution and clearance were absent in a significant number of studies effectively abrogating calculation of a meaningful dosing regimen.

Figure 1

(abstract P275)Reporting of required parameters for dose regimen calculation in the literature.

Conclusion

A large proportion of current studies do not report key information necessary to devise a rational dosing regimen for patients with acute renal failure receiving continuous renal replacement therapy. We have presented a set of criteria we believe are necessary to calculate an antibiotic-dosing regimen for these patients and hope this will be a useful guide when reporting future pharmacokinetic data.