This has come up in Question 15.2 from the second paper of 2013. Question 13 from the first paper of 2010 also mentions it on a tangent. An excellent resource exists, which has more information on this topic. One can also pay eighty quid to publishers of the Renal Drug Database. The information below relates more to patients with renal impairment, rather than those who are subjected to regular or continuous dialysis (that is a topic for another chapter).
- Beta-lactams can be either dose-adjusted or interval-adjusted
- Carbapenems can be either dose-adjusted or interval-adjusted
- Aminoglycosides keep the same dose, and are interval-adjusted (with monitoring of drug levels)
- Fluoroquinolones keep the same dose, and are interval-adjusted (with monitoring of the QT interval)
- Glycopeptides keep the same dose, and are interval-adjusted (with monitoring of drug levels)
The main issue to keep mindful of is the reliance of the drug on renal excretion. The greatest disadvantage here is not to antimicrobial efficacy, but to the patient - accumulation will result in toxicity.
A peripheral issue is the killing characteristic of that drug; in renal failure the concentration-dependent killers are largely unaffected, whereas the time-dependent killers enjoy a prolonged period of time at a satisfactory concentration over MIC.
For a historical footnote, Linton and Lawson from the Western Infirmary of Glasgow published an editorial about this back in 1970.