Table 9.

Summary of dosing recommendations during continuous RRT for common antimicrobials utilized in patients who are critically ill

CRRT DoseEstimated clearanceVancomycinCefepimePiperacillin-TazobactamMeropenemAmikacinAcyclovirOseltamivir
ReferencesChurchwell and Mueller (65)Churchwell and Mueller (65)Moriyama et al. (73)Moriyama et al. (73)Moriyama (et al.73)D’Arcy et al. (74)Churchwell and Mueller (65)Flannery Thompson Bastin (75)
LexicompSeyler et al. (71)Seyler et al. (71)Seyler et al. (71)Lam and Bauer (76)LexicompLexicomp
Chaijamorn et al. (77)LexicompLexicompTaccone et al. (78)
Shaw and Mueller (79)Roger et al. (80)
LexicompLexicomp
Replacement 1 L/h prefilter 1 L/h postfilter2000 ml/h + 2000 ml/h+ 200 ml/h =70 ml/min25 mg/kg loading dose (3250 mg)2 g loading dose4.5 g loading dose2 g loading doseApproximately 25 mg/kg (adjusted BW of 90 kg)10 mg/kg (IBW 68 kg) loading dose75 mg q 12h
Dialysate 2 L/h(14 mg/kg actual BW) 1750 mg q24h2 g q8h extended or continuous infusion4.5 g q6h extended or continuous infusion1–2 g q8h extended infusion2250 mg q48h680 mg 680 mg q8h
UF 200 ml/h10 mg/kg (IBW) q8h (encephalitis dosing)
Physiochemical propertiesAlways assess for residual UOP during therapy, and take into consideration set downtimeMW: 1485 dMW: 480 dMW: 500 dMW: 383 dMW: 585 dMW: 225 dMW: 312 d
PB: 55%PB: 20%PB: 30%PB: 2%PB: 11%PB: 33%PB: 3%
Vd: 0.7 L/kgVd:0.28 L/kgVd: 0.24 L/kgVd: 0.2 L.kgVd: 0.25 L/kgVd: 0.8 L/kgVd: 0.37 L/kg
Maintenance dose on the basis of40–50 ml/min eGFR70 ml/min70 ml/min70 ml/min70ml/min70 ml/min70 ml/min
CaveatsConvective clearance > diffusive clearance. Can use population PK estimated for dosing interval, once determined from CRRT Rx.Total clearance of 70 ml/min requires full unadjusted dose, consider dose reduction after 48–72 h on the basis of cultures, indication etc.TDM after first dose.Will require adjustments if eGFR <50 ml/min.Excellent absorption even in shock/CRRT/ECMO. Supratherapeutic levels achieved with normal dosing.
TDM at steady state.
  • BW, body weight; IBW, ideal body weight; MW, mol wt; PB, protein binding; Vd, volume of distribution; UOP, urine output; TDM, therapeutic drug monitoring; CRRT, continuous RRT; ECMO, extracorporeal membrane oxygenation; Rx, prescription.