Dosing Regimes for Antimicrobials during Continuous Veno-Venous Haemofiltration (CVVH)

The pharmacokinetic profile of antibiotics used in critically ill patients during continuous haemofiltration is different both from healthy people and from stable patients on long-term dialysis. This article reviews the patient-related, drug-related and haemofiltration-related variables influencing drug elimination in this group of patients, and provides specific recommendations for antibiotic dosing for different classes of antibiotics. Loading doses do not need to be altered. Subsequent dose adjustment should be based on the estimated ultrafiltration capacity of the renal replacement technique and the degree of extracorporeal clearance. A table of recommended doses is provided.