Researchers of INCLIVA recommend the individualization of antimicrobial doses in critically ill patients with renal insufficiency and continuous renal replacement therapy

Researchers of INCLIVA recommend the individualization of antimicrobial doses in critically ill patients with renal insufficiency and continuous renal replacement therapy

⇒ The results of the study have been published in the International Journal of Antimicrobial Agents. Antimicrobials are drugs often used in intensive care units (ICUs) to treat serious infections caused by bacteria or fungi. The first are treated with antibiotics, the second with antifungals. Patients currently admitted to the intensive care units, due to their high level of severity, sometimes require extracorporeal support techniques, such as continuous renal replacement therapy. Pharmacokinetics is the study of the processes to which a drug is subjected through its passage through the body. In this sense, the pharmacokinetics of antifungals in critically ill patients with different extracorporeal devices constitutes an open line of research in INCLIVA during the last years. The Anaesthesiology and Resuscitation Service, the Hospital Pharmacy Service and the Microbiology Service of the University Clinical Hospital of Valencia have been working together. This has generated different publications in scientific journals with a high impact factor. Casponfungin is an antifungal commonly used in ICU. The first study of this group of researchers on caspofungin pharmacokinetics in patients with renal failure and continuous renal replacement therapy was published in January 2017 in the journal Critical Care. Based on the plasma concentrations of the patients analyzed in the previous study, a population pharmacokinetic model (Montecarlo simulation) was developed to generate the current study. Its objective was to evaluate the efficacy of different doses of caspofungin in a new population of critically ill patients with renal failure and continuous renal replacement therapy. As in the previous study (12 patients), the authors conclude, analyzing this time a larger population (10,000 patients), that the doses recommended in the technical data sheet of this antifungal agent may be insufficient in this type of patient. Additionally, they propose a therapeutic scheme that would allow to individualize the doses of caspofungin, taking into account the minimum inhibitory concentration (MIC) of the growth of the microorganism responsible for the infection.

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  • Pérez-Pitarch A, Ferriols-Lisart R, Aguilar G. Dosing of caspofungin based on a pharmacokinetic/pharmacodynamic index for the treatment of invasive fungal infections in critically ill patients on continuous venovenous haemodiafiltration Int J Antimicrobial Agents 2018 Jan;51(1):115-121.
  • Aguilar G, Ferriols R, Lozano A et al. Optimal doses of caspofungin during continuous venovenous hemodiafiltration in critically ill patients. Crit Care 2017 Jan 30;21(1):17.
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