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Year : 2022  |  Volume : 6  |  Issue : 2  |  Page : 43-49

Evaluation of standard dosing for selected broad-spectrum Hydrophilic antibiotics in critically ill patients with Augmented renal clearance: An Observational Study

1 Department of Pharmaceutical Care, King Abdulaziz Medical City, Riyadh, Saudi Arabia
2 Department of Pharmaceutical Care, King Abdulaziz Medical City; Department of Pharmaceutical Care, College of Pharmacy, King Saud Bin Abdulaziz University for Health Sciences; King Abdullah International Medical Research Center; Saudi Critical Care Pharmacy Research (SCAPE) Platform, Riyadh, Saudi Arabia
3 Department of Pharmaceutical Care, College of Pharmacy, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
4 King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
5 Department of Pharmacy Practice, Faculty of Pharmacy, King Abdulaziz University, Jeddah, Saudi Arabia

Correspondence Address:
Khalid Al Sulaiman
Abdulaziz Medical City (KAMC) - Ministry of National Guard Health Affairs (MNGHA), King Abdullah International Medical Research Center/King Saud bin Abdulaziz University for Health Sciences, PO Box 22490, 11426 Riyadh
Saudi Arabia
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/sccj.sccj_26_21

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Background: Inappropriate antibiotic dosing in critically ill patients with augmented renal clearance (ARC) may be associated with pathogens' resistance and worse outcomes. Unfortunately, studies regarding the relationship between ARC and clinical outcomes in patients treated with antibiotics are scarce. This study aims to evaluate selected broad-spectrum hydrophilic antibiotics' effectiveness and clinical outcomes in ARC critically ill patients with confirmed infections. Methods: A retrospective a retrospective cohort study in adult critically ill patients who were admitted to intensive care units at King Abdulaziz Medical City, Riyadh, and received standard dosing of selected broad-spectrum hydrophilic antibiotics (meropenem, imipenem, or piperacillin/tazobactam) with confirmed infection. All the patients who met our eligibility criteria during the study period (January 1, 2018, to December 31, 2019) were included. According to the calculated creatinine clearance using the Cockcroft-Gault equation, eligible patients had been classified into two groups: ARC versus non-ARC. The primary outcome was to assess pathogen eradication at 10–14 days; other outcomes were considered secondary. Multivariate logistic and generalized linear regression analyses were used. We considered P < 0.05 statistically significant. Results: A total of 133 patients were included in the study; 66 patients had ARC. The distribution of infections and types of pathogens between the groups were similar. The pathogen eradication at 10–14 days was similar between the two groups (odds ratio [OR] 1.08; 95% confidence interval [CI], 0.41–2.78; P = 0.88). Moreover, the odds of resistance development and persistence after three days were not significantly different between the two groups ([OR 0.78; 95% CI, 0.25–2.40; P = 0.66] and [OR 0.88; 95% CI, 0.35–2.18; P = 0.78], respectively). Conclusion: In terms of pathogen eradication, resistance, and persistence, ARC patients and non-ARC patients responded similarly to conventional doses of hydrophilic broad-spectrum antibiotics. To confirm our findings, further randomized controlled clinical trials are needed.

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