Doripenem dosing regimens in Asian critically ill patients with continuous renal replacement therapy (2019)
Title : Doripenem dosing regimens in Asian critically ill patients with continuous renal replacement therapy (2019)
Researcher : Chaijamorn, W., Puchsaka, P.W., Pattharachayakul, S., …Boonpeng, A., Pummangura, C.
Abstract : Antibiotic dosing in critically ill patients with continuous renal replacement therapy (CRRT) is still challenging. Pharmacokinetic changes in critically ill patients such as increased volume of distribution and decreased protein binding affinity affect hydrophilic drug dosing regimens [1]. Consequently, we might prescribe inadequate doses of antimicrobial agents in patients with CRRT [1] which can affect the morbidity and mortality associated with sepsis [2]. Requirement of loading dose and higher maintenance doses for this group of patients has been suggested to achieve pharmacokinetic and pharmacodynamic targets [3].
Continuous renal replacement therapy has been utilizing to effectively remove fluid and waste products in this group of patients due to hemodynamic instability [4]. Doripenem is a water-soluble carbapenem antibiotic and commonly used for Gram negative infection in intensive care unit (ICU) [5]. It can be removed by CRRT due to small molecular weight (438.52 Da) and low volume of distribution (16.8 L) [6].
The recommended dosing regimens from clinical resources are mostly from the pharmacokinetic studies in Western patients and there were a few studies conducted in Asian population [[7], [8], [9], [10], [11], [12]]. No suggested doripenem dosing regimens for CRRT patients based on Asian pharmacokinetic parameters exists. This study aimed to define the optimal doripenem dosing regimens using pharmacokinetic parameters from Asian population and body weights of Asian critically ill patients and to evaluate the probability of target attainment (PTA) of recommended dosing regimens from available clinical resources.
Link to article: https://doi.org/10.1016/j.jcrc.2019.04.030
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