Antibiotic dose optimization for specific patient populations With focus on patients with renal impairment

Appropriate antibiotic use is beneficial for patients’ clinical outcome, leads to a decrease in antibiotic resistance rates and results in lowering of healthcare costs. Appropriate antibiotic use is defined by quality indicators. One of these quality indicators is to adjust (i.e., reduce) the antibiotic dose to renal function, which is standard of care and incorporated in all clinical guidelines. However, this dose reduction is often not applied in clinical care. Inconsistency exists between different guidelines in the recommended dose reduction. Additionally, significantly increased therapeutic failure and death were observed in patients with impaired renal function treated with recommended reduced doses of antibiotics.
We investigated the adequacy of the guideline-recommended dose reduction of renally cleared antibiotics for patients with impaired renal function. Furthermore, to be able to fully investigate the adequacy of the administered antibiotic dose, we also investigated that other pharmacokinetic parameter determining drug exposure: the bioavailability (i.e., absorption). Therefore, we studied the absorption of oral ciprofloxacin in neutropenic patients with haematological malignancies and mucositis.
The ultimate goal is to strengthen the evidence underlying the quality indicator for appropriate antibiotic use on ‘adjusting the dose to renal function’ and provide evidence that adherence to that quality indicator actually leads to appropriate antibiotic use.