Antimicrobial dosing considerations in critically ill patients with acute kidney injury: A review

Abstract

Sepsis-associated acute kidney injury is common in critically ill patients and is strongly associated with an increased risk of adverse outcomes and mortality. While early and appropriate antimicrobials for sepsis have been associated with an increased probability of survival, adequate dosing is a challenge in these patients. Critical illness with acute kidney injury is characterized by marked physiological derangements. This impacts the pharmacokinetic and pharmacodynamic profiles of antimicrobials, which complicates the predictability of drug disposition. Conventional antimicrobial dosing may not be optimal in this patient population, leading to under or overexposure to antimicrobials. This review summarizes an overview of the drug dosing considerations and relevant evidence of appropriate dosing strategies of common antimicrobials encountered in critically ill patients with acute kidney injury to optimize therapeutic efficacy and to reduce toxicity and adverse events.

Keywords: Antimicrobials; Acute kidney injury; Dialysis; Sepsis; Critical illness; Pharmacokinetics; Pharmacodynamics

Core Tip: Currently, there are few published reviews focusing on dosing considerations for critically ill patients with acute kidney injury across key antimicrobial categories, including antibiotics, antivirals, and antifungals. Recognizing how physiological changes affect drug-related pharmacokinetics and pharmacodynamics in this context can help guide dosing strategies to enhance clinical outcomes for these patients.