DOSING ADJUSTMENT OF 10 ANTIMICROBIALS FOR PATIENTS WITH RENAL IMPAIRMENT

OBJECTIVE: TO describe a program of creatinine clearance-based dosage adjustment of 10 renally eliminated antimicrobial agents and to discus s the utility of such a program in a hospital as a method of quality a ssurance (by ensuring that patients with renal impairment receive gene rally accepted dosage adjustments), based on pharmacodynamic principle s. METHODS: Consecutive patients prescribed any of 10 targeted renally eliminated antibiotics were included. Recommendations for dosage adju stment were made to the prescriber based on a calculated creatinine cl earance. Additional adjustments in drug therapy were performed, includ ing dosage recommendations of nontargeted drugs, simplification of ant ibiotic regimens, and conversion of intravenous to oral therapy. A cos t analysis was performed. RESULTS: During a B-month study period, 160 dosage changes (7.6% of total number screened) were recommended in 137 patients receiving the targeted antimicrobial agents. Prescribers acc epted 147 recommendations (91.9%). A dosage change recommendation was necessary more than 12% of the time for acyclovir, ceftazidime, and im ipenem/cilastatin, A cost avoidance of $11 702.08 was realized. Ancill ary drug recommendations that were offered acid accepted during the pr ogram realized a cost avoidance of $6613.75. CONCLUSIONS: This dosage adjustment program using pharmacodynamic principles was successful in optimization of dosing, potential minimization of morbidity caused by excessive dosing, and demonstration of direct and potentially indirect cost avoidance. A dosing program for patients with renal impairment w ould be of benefit to other clinicians and institutions seeking to opt imize patient care.