Evaluation of antibiotic prescribing patterns in patients receiving sustained low-efficiency dialysis: opportunities for pharmacists
Article first published online: 9 JUL 2012
© 2012 The Authors. IJPP © 2012 Royal Pharmaceutical Society
International Journal of Pharmacy Practice
Volume 21, Issue 1, pages 55–61, February 2013
How to Cite
Harris, L. E., Reaves, A. B., Krauss, A. G., Griner, J. and Hudson, J. Q. (2013), Evaluation of antibiotic prescribing patterns in patients receiving sustained low-efficiency dialysis: opportunities for pharmacists. International Journal of Pharmacy Practice, 21: 55–61. doi: 10.1111/j.2042-7174.2012.00226.x
- Issue published online: 10 JAN 2013
- Article first published online: 9 JUL 2012
- Manuscript Accepted: 3 MAY 2012
- Manuscript Received: 16 SEP 2011
- antibiotic dosing;
- drug clearance;
- kidney failure;
- prescribing practices;
- sustained low-efficiency dialysis
Sustained low-efficiency dialysis (SLED) is a ‘hybrid’ form of continuous renal replacement therapy; however, there is very limited information on drug disposition during this procedure. Individuals requiring SLED are often critically ill and require antibiotics. The study aim was to evaluate antibiotic orders for patients requiring SLED compared to literature-based recommendations. We also evaluated whether doses were administered as prescribed and assessed clinical and microbiologic cure.
A retrospective review was performed over a 2-year period for patients who received concurrent SLED and antibiotic therapy. Demographic data, prescribed antibiotic dosing regimens and doses delivered as prescribed were determined for 10 antibiotics: cefepime (C), daptomycin (Da), doripenem (D), gentamicin (G), imipenem-cilastatin (I), linezolid (L), meropenem (M), piperacillin-tazobactam (P), tobramycin (T) and vancomycin (V). Dosing regimens were compared to recommendations from the literature where available. The incidence of clinical and microbiologic cure was also evaluated.
A total of 87 patients met inclusion criteria: mean age 54 ± 14 years, 60% male, 58% white. Prescribed doses were evidence-based for 37% of Da, 97% of L, 15% of M and 7% of V orders. The majority of discrepancies were due to under-dosing. There were 129 (11%) antibiotic doses missed. Of the 13 patients who met criteria for assessment of clinical and microbiologic cure, 10 achieved a microbiologic cure and none reached clinical cure.
Prescribed antibiotic dosing regimens varied substantially and under-dosing was common. There is a need to further define appropriate dosing regimens for antibiotics administered during SLED and determine how pharmacists may help to ensure appropriate therapy.