The Impact of Different Renal Function Measuring Methods on the Dosages of Meropenem, Piperacillin/Tazobactam and Cefepime in Critically Ill Patients

Diego del Río, E.; Soy Muner, D.; Gratacós Santanach, L.; Ribas Sala, J.

doi:10.1016/S2173-5085(08)70041-8

Farmacia Hospitalaria

ISSN: 1130-6343

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Assessment of dosage deviations of 3 β-lactam antibiotics eliminated through the kidneys (meropenem, piperacillin/tazobactam, and cefepime) by comparison of 2 prediction formulae, Cockroft-Gault (CG) and Modification of Diet in Renal Disease (MDRD) with 24 h urinary creatinine clearance (CrCl24h), as a reference method.

Method

125 samples of 61 critically ill patients (each one with CG, MDRD and CrCl24h values) were classified in one of the 5 stages of the National Kidney Foundation (NKF) according to CrCl24h. Dosage discrepancies for each antibiotic based on CG and MDRD were studied in reference to CrCl24h by percentage agreement and weighted kappa. At each of the NKF stages, daily dosage differences (β=DoseCG-DoseCrCl24h; β=DoseMDRDDoseCrCl24h) and percentage of samples with dosage discrepancies by CG and MDRD in reference to CrCl24h were calculated.

Results

There were no statistically significant differences between the 2 prediction formulae in respect to CrCl24h, achieving good degrees of concordance. Deviation percentages fluctuated between 15.2% and 28% and occurred mainly by underdosing on stages 1 and 2 and by overdosing on stages 4 and 5.

Conclusions

The 2 renal function prediction formulae can be indistinctly used to optimize the β-lactam antibiotics dose regimen, CG being the easiest one.

Key words:

β-lactam antibiotics

Glomerular filtration

Cockcroft-Gault

MDRD

Critically ill patients

Objetivo

Evaluar las desviaciones de dosificación de 3 antibióticos betalactámicos eliminados por vía renal (meropenem, piperacilina/ tazobactam y cefepima) mediante la comparación de 2 fórmulas de predicción de función renal, Cockroft-Gault (CG) y Modification of Diet in Renal Disease (MDRD), con el aclaramiento de creatinina en orina de 24h (ClCr24h) como método de referencia.

Método

Las 125 muestras de 61 pacientes (cada una con sus valores de CG, MDRD y ClCr24h) de una unidad de cuidados intensivos (UCI) se clasificaron en los 5 estadios definidos por la National Kidney Foundation (NKF) en función del ClCr24h. Se estudiaron las discrepancias de dosificación de cada antibiótico según CG o MDRD en referencia al ClCr24h por acuerdo porcentual e índice kappa ponderado. En cada estadio de NKF se cuantificaron las diferencias de dosificación diaria (Δ= DosisCGDosisClCr24h; Δ= DosisMDRD-DosisClCr24h) y el porcentaje de muestras con discrepancias de dosificación por CG y MDRD en referencia al ClCr24h.

Resultados

En ningún caso se observaron diferencias estadísticamente significativas entre ambas fórmulas con respecto al ClCr24h, obteniendo grados de concordancia buenos. Los porcentajes de desviaciones oscilaron del 15,2% al 28% y ocurrieron mayoritariamente por infradosificación en los estadios 1 y 2, y por sobredosificación en los estadios 4 y 5.

Conclusiones

Las dos predicciones de función renal en pacientes de la UCI pueden ser empleadas indistintamente para la dosificación de betalactámicos, aunque la de CG es la más sencilla.

Palabras clave:

Antibióticos betalactámicos

Filtrado glomerular

Cockcroft-Gault

MDRD

Pacientes críticos

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