Antibacterial chemotherapy in patients with renal insufficiency and liver dysfunction.

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The pharmacokinetics of renally excreted β-lactams, aminoglycosides, and glycopeptides were studied in patients with renal dysfunction classified into 4 categories by 24-hour creatinine clearance (Ccr):(1) normal function (Ccr>70mL/minute), (2) minimum dysfunction (70>Ccr>50mL/minute), (3) moderate dysfunction (50>Ccr>30mL/minute), and (4) severe dysfunction (30mL/minute>Ccr). A significant correlation was seen between β and Ccr, generally implying that dosage regimens for renallv excreted drugs can be determined based on Ccr. In Ccr 50mL/minute, a half dosage at regular intervals or regular dosage at double intervals is recommended. In Ccr 30mL/minute, one third dosage at regular intervals or regular dosage at triple intervals is recommended. For drugs with narrow safety windows such as vancomycin and aminoglycosides, similar dosage regimens are apply, but doses carefully adjusted based on therapeutic drug monitoring is essential to ensure therapeutic effects and the prevention of side effects. Hepatic dysfunction induced by antimicrobial agents is often attributed to an allergic reaction. In such cases, antimicrobial agents with a different structural formula should be selected. For patients with hepatic dysfunction, agents with high bile excretion should be avoided.
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