Antibiotic Dosing Adjustments in Hospitalized Patients with Chronic Kidney Disease: a Retrospective Chart Review

Overview

Journal Int Urol Nephrol

Publisher Springer

Specialty Nephrology

Date 2021 Mar 19

PMID 33738646

Citations 4

Authors

Bahia Chahine

Affiliations

Soon will be listed here.

Abstract

Background: Infections in patients with chronic kidney disease (CKD) are a major cause of hospitalization. The pharmacokinetics of renally eliminated antibiotics may lead to drug accumulation, resulting in potential toxicity. The renal dosing adjustment of antibiotics is crucial to avoid toxicity and decrease mortality. In Lebanon, limited data are available on antibiotic dose adequacy in CKD.

Objectives: To estimate the prevalence of inappropriately dosed antibiotics in non-dialysis CKD patients and to identify possible risk factors that may be associated with unadjusted renal dosing.

Methods: A retrospective chart review was conducted at two tertiary-care hospitals in Lebanon. International Statistical Classification of Diseases (ICD-10) code for CKD was used to search the databases. Demographic and clinical data were collected for patients who received antibiotics that requires renal dosing adjustment. Lexi-Comp online Drug Information database was the guideline used to evaluate the appropriateness of dosing.

Results: A total of 495 antibiotic orders were dispensed to 190 patients. 51.6% of patients received antibiotics without renal dose adjustments. The most inappropriately dosed class was penicillins (39.8%), while fluoroquinolones were the most adequately adjusted. Piperacillin/tazobactam was the most frequently prescribed drug (30.6%) without renal dose adjustment. Respiratory infections (OR 1.301, CI 95% 1.327-1.915) and multimorbidity (OR 1.183, CI 95% 1.358-2.081) were statistically highly significant associations for unadjusted antibiotic dosing from the fitted multivariable-adjusted logistic models.

Conclusion: Our study revealed a high frequency of guideline-discordant antibiotic dosing in patients with CKD. This dosing error is preventable by increasing awareness of prescribing physicians and collaborating with clinical pharmacists.

Citing Articles

Physiologically-based pharmacokinetic modeling for single and multiple dosing regimens of ceftriaxone in healthy and chronic kidney disease populations: a tool for model-informed precision dosing.

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Drug Utilization Evaluation and Impact of Pharmacist Interventions on Optimization of Piperacillin/Tazobactam Use: A Retrospective Analysis and Prospective Audit.

Arain S, Khalawi F, Parakkal S, AlHamad H, Thorakkattil S, Alghashmari F Antibiotics (Basel). 2023; 12(7).

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Antimicrobial Stewardship and Dose Adjustment of Restricted Antimicrobial Drugs in Hospital Setting.

Vlak I, Samardzic I, Marinovic I, Busic N, Vrca V Pharmacy (Basel). 2023; 11(2).

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Liu E, Linder K, Kuti J Antibiotics (Basel). 2022; 11(8).

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