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Clinical pharmacy and clinical trials (including case series)
Pharmaceutical interventions in antibiotic dosage adjustment in renal impairment. Clinical implications.
  1. C. Casado,
  2. V. Saavedra,
  3. A. Díez,
  4. A. Torralba
  1. 1H.Puerta de Hierro Majadahonda Pharmacy Service Madrid, Spain


Background Drug dose adjustment in renal impairment is basic in pharmaceutical validation.

Purpose To evaluate the acceptance of pharmaceutical interventions during the validation of antibiotic treatments in patients with impaired renal function.

Materials and methods Retrospective observational study of pharmaceutical interventions (PIs) for dose adjustment in renal impairment, in patients treated with levofloxacin, ciprofloxacin, meropenem, ertapenem, amoxicillin/clavulanic acid or piperacillin/tazobactam, in the period January 2010-September 2011.

The data collected were: number of clinical history, age, sex, weight, serum creatinine and clinical department. The creatinine clearance was calculated using the Crockcroft-Gault formula. Patients were classified according to renal clearance in 3 groups: A (CrCl 50-30 ml/min), B (CrCl 29-10 ml/min), C (CrCl < 10 ml/min). The dosage adjustments recommended were based on the summary of product characteristics and the antimicrobial treatment guide published by J. Mensa et al. in 2011.

Results The total number of patients whose antibiotic dose had to be adjusted because of the creatinine clearance was 139 (58 men and 81 women), with an average age of 82. Of the patients, 67% were prescribed levofloxacin, 8.6% ciprofloxacin, 14% meropenem, 9% ertapenem, 29% amoxicillin/clavulanic acid and 8% piperacillin/tazobactam. 27.3% of patients were in group A, 70.5% in group B and 2.2% in C. The overall percentage of acceptance of the PI was 79.1%. For antibiotic treatment, the acceptance rate for levofloxacin was 85%, ciprofloxacin 41.6%, ertapenem 77.7%, meropenem 92.8%, amoxicillin/clavulanic acid 82.7% and 50% for piperacillin/tazobactam. 55.4% of interventions were made in the Internal Medicine ward.

Conclusions The high degree of acceptance of pharmaceutical interventions among prescribers promotes the integration of the pharmacist in multidisciplinary teams.

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