Antimicrobial stewardship of dosing regimen with continuous renal replacement therapy and extracorporeal membrane oxygenation

Abstract

Antimicrobial dosing for critically ill patients that is derived from other patient groups is likely to be suboptimal because of significant antibiotic pharmacokinetic changes, particularly in terms of drug volume of distribution and clearance. Organ support techniques including continuous renal replacement therapy (CRRT) and extracorporeal membrane oxygenation (ECMO) increase the pharmacokinetic variability. This article topics the recently published antibiotic pharmacokinetic data associated with infectious disease, those receiving CRRT and ECMO. In the content of such variable pharmacokinetics, a guideline approach to dosing remains elusive because of insufficient available data and, therefore, antimicrobial stewardship including TDM should be considered advantageous where possible.