ANTIBIOTICS IN RENAL-FAILURE PATIENTS

Two ways to adjust dosage: Dosage can be adjusting either by extending dose intervals or simply reducing each dose. Circumstances: Not all d rugs require a modification of the dosage regiment In general, dosage must be adapted when renal failure is patent, i.e. when glomerular fil tration is greatly reduced as shown by creatinine clearance below 30 m l/min. The best way to modify dosage: For any given antibiotic, the be st way to maintain blood levels above the minimal inhibitory concentra tion for the causal germ is to extend the dosage interval without chan ging each dose. Careful monitoring: All renal failure patients on anti biotics must be carefully monitored for toxic effects. Choosing a drug with intestinal excretion may not eliminate all risks since metabolit es may nevertheless be excreted in urine. Infections complications in renal disease: Referral to a specialized unit may be necessary to avoi d septicemia, endocarditis, suppuration of intrarenal cysts, infection of vascular puncture sites, infection of peritoneal dialysis fluid, o r bacterial or viral infections in less resistant patients, particular ly after immunosuppressive therapy. (C) 1997, Masson, Paris.