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      Augmented renal clearance in critically ill patients: etiology, definition and implications for beta-lactam dose optimization.

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          Abstract

          The renal clearance of antibiotics may be elevated in some critically ill patients. This paper reviews this recently described phenomenon, referred to as augmented renal clearance (ARC). ARC is considered to be driven by pathophysiological elevation of glomerular filtration, and is defined as a creatinine clearance >130mL/min/173m(2). This in turn promotes very low antibiotic concentrations. This effect may lead to adverse clinical outcomes, particularly with beta-lactam antibiotics, as they require prolonged exposure for optimal antibacterial activity. The use of extended or continuous infusions is an effective strategy to improve exposure. However, because the effect of ARC is potentially quite variable, regular therapeutic drug monitoring (TDM) may be necessary to ensure all patients achieve effective concentrations.

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          Author and article information

          Journal
          Curr Opin Pharmacol
          Current opinion in pharmacology
          1471-4973
          1471-4892
          Oct 2015
          : 24
          Affiliations
          [1 ] Burns, Trauma, and Critical Care Research Centre, University of Queensland, Herston, Brisbane, Queensland, Australia.
          [2 ] Burns, Trauma, and Critical Care Research Centre, University of Queensland, Herston, Brisbane, Queensland, Australia; Department of Intensive Care and Hyperbaric Medicine, The Alfred Hospital, Commercial Road, Melbourne, VIC 3181, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Commercial Road, Melbourne, VIC 3181, Australia.
          [3 ] Burns, Trauma, and Critical Care Research Centre, University of Queensland, Herston, Brisbane, Queensland, Australia; Royal Brisbane and Women's Hospital, Herston, Brisbane, Queensland, Australia. Electronic address: j.roberts2@uq.edu.au.
          Article
          S1471-4892(15)00072-7
          10.1016/j.coph.2015.06.002
          26119486
          Copyright © 2015 Elsevier Ltd. All rights reserved.

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