Briefly outline the dosing adjustment and the monitoring necessary for each of the following drug groups in patients with established septic shock and moderate to severe renal dysfunction (without dialysis):

1. Aminoglycosides
2. Fluoroquinolones
3. Beta-Lactams
4. Carbapenems
5. Glycopeptides

• Aminoglycosides
• High initial dose and monitor trough concentrations. Extend interval. May be necessary to decrease dose and monitor with MIC data
• Fluoroqinolones
• Reduce frequency but maintain dose.
• Monitor QT interval
• Beta Lactams
• Can reduce dose OR frequency
• Monitoring unnecessary
• Carbapenems
• As for Beta Lactams
• Glycopeptides
• High dosing on day one dose adjustments according to Cmin and dependent on degree of renal dysfunction

Discussion

Another question which relies on memory rather than on the capacity to reason. However, the classes of antibiotics discussed here are common ones, and one should be intuitively familiar with their use.

In a brief summary: