Appropriatetiminganddosingofantibioticsinsepsis-Surviving.ppt

Revised Patient Case LL is a 26yo patient with a history of a MVC 7 days ago who develops respiratory distress and hypotension on the floor. He is emergently intubated, transferred to the ICU and fluid resuscitated with 3L of NS. LL has NKDA, weighs 91kg and his current SCr=0.4 mg/dl His SCr on admission= 0.7 mg/dl Cefepime, ciprofloxacin and vancomycin are written for – What doses should be given? Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile 5.2.0.0. Copyright 2004-2011 Aspose Pty Ltd. Renal Function – Augmented Renal Clearance Definition: CrCl value 10% above the upper limit of normal At risk for subtherapeutic dosing, treatment failure and development of resistant organisms Patients at risk: younger patients (~55 years), post trauma (especially head injuries), post-op, sepsis, burns and hematologic malignancies Not a lot of data Recommendations: Use timed CrCl collections to determine renal function May need to use continuous infusions for beta-lactams and vancomycin Use therapeutic drug monitoring when available What dose to give? Clin Pharmacokinet 2010;49:1-16 Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile 5.2.0.0. Copyright 2004-2011 Aspose Pty Ltd. Revised Patient Case LL is a 45yo patient with a history of a renal transplant in 2007 who presents with respiratory distress and hypotension. He is emergently intubated in the ER and fluid resuscitated with 3L of NS. LL has NKDA, weighs 91kg, his admit SCr=1.2 mg/dl and his AST=1245 U/l (nl 0-50), ALT=2312 U/l (nl 12-78) and his tbili=1.5 mg/dl (nl 0-1.4) Cefepime, ciprofloxacin and vancomycin are written for – What doses should be given? Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile 5.2.0.0. Copyright 2004-2011 Aspose Pty Ltd. Hepatic Dysfunction Not a lot of data, especially with acute dysfunction No simple endogenous marker to predict function clinically used No available dosing adjustment tables Manufacturers, mostly for newer