Adjust Your Adjustments: Considerations for Delayed Antibiotic Renal Dose Adjustments

by Matthew Songin Patient Caseson Posted on

A 48-year-old male presents with septic shock due to perforated diverticulitis. His eCrCL on admission is 32 ml/min whereas last month at an outpatient checkup it was 99 ml/min. Pip-tazo is ordered. Should the dose be immediately adjusted for renal impairment?

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Best Answer

No

Explanation: Patients presenting with sepsis or septic shock often experience transient AKIs. Delaying renal dose adjustments of antimicrobials such as β-lactams by 24 to 48 hours may be beneficial, as the acute risk for underdosing outweighs the risks of overdosing. In a prospective, observational study that evaluated the effect of timing for antipseudomonal β-lactam dose adjustments in 224 critically ill patients with sepsis and AKI, the late β-lactam adjustment group (> 24 hours of sepsis recognition) was associated with reduced in-hospital mortality in an adjusted model (HR 0.588, 95% CI 0.355-0.974).

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