MONITORING THE ANTIMICROBIAL THERAPY OF THE PATIENTWITH CHRONIC KIDNEY DISEASE USING THE PHARMACOKINETIC CRITERIA
Abstract:
Therapeutic Drug Monitoring (TDM) in Chronic Kidney Disease (CKD) remains a permanent
challenge for nephrologists especially when such pathology is associated with infectious phenomena
which require a rapid and radical treatment, but at the same time a personalized one. We have
conducted a prospective study which included 40 patients with CKD stages 3, 4, 5 treated with
ciprofloxacin in different dosages, according to glomerular filtration rate, in order to eradicate certain
microorganisms sensitive to this antibiotic. The research was conducted over a period of 42 months in
the Department of Nephrology of Mureş Clinical County Hospital. In the studied group, during the
therapy, a number of 55 side effects were recorded secondary to the administration of ciprofloxacin,
more frequent in the case of those in end stage of CKD, even if the dosage was 50% smaller. That is
why, it is mandatory that patients who are in end stage of CKD, stage 4 and 5, being more vulnerable,
should benefit from a more complex evaluation such as pharmacokitnetic investigations in view of an
optimum dosage adjustment of potentially nephrotoxic drugs. Therapeutic drug monitoring of the patient
with CKD should include clinical assessment and laboratory, pharmacokinetic parameters for a correct
dosage, in order to avoid over or under dosage of a potentially nephrotoxic treatment
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