Correlation Between Dose Adjustment of Antiviral and Antibiotic with Therapeutic Outcomes for Inpatients with COVID-19 and Chronic Kidney Diseases

Introduction: Chronic kidney disease (CKD) is associated with worsening and death from CO VID-19. COVID-19 patients with CKD who are hospitalized need antivirals and/or antibiotics that require dose adjustments [1]. Furthermore, dose adjustment for patients with CKD will decrease the adverse drug reaction, reduce the length of stay and death, and decrease therapy costs [2]. Glomerular filtration rate (GER) remains a gold standard for adjusting medication doses in CKD patients. Aim: To evaluate the dose adjustment of antivirals and/or antibiotics and analyze its relation with therapeutic outcomes and length of stay for COVID-19 patients with CKD. Methods: A cross-sectional study with a total sampling method was performed at a hospital in Java Island, Indonesia. All inpatients above 17 years old with COVID-19 and CKD that received antibiotics and or antiviral from January-December 2021 were included in this study. Data were collected from the medical record patient. The dose adjustment patient was calculated using patient GER using the CKD-EPI method according to published references [3-5]. In this study, the outcome therapy was divided into improvement and death. Results: 70 (51.1%) of 137 patients received inappropriate doses. The inappropriate dose adjustment was higher for antivirals compared to antibiotics. Antivirals that were given inappropriately were favipiravir (94,6%), oseltamivir (35,5%), and remdesivir (45,0%). Meanwhile, cefixime (5,4%) and ceftriaxone (1,7%) were antibiotics with inappropriate doses. The data showed that 53,3% of patients improved while 46,7% died. Patients with appropriate doses tended to be 2,236 times higher to achieve improved therapeutic outcomes than patients with inappropriate doses (p = 0.032). The median length of stay for patients with appropriate doses adjustment was longer than the inappropriate, respectively 9,0 (1-31) days and 8,0 (1-35) days. The appropriateness of dose adjustment did not statistically signifi-cantly influence the length of stay for patients with COVID-19 and CKD (p >0,05). Conclusions: The appropriate dose adjustment of antibiotics and/or antivirals increases the improved therapeutic outcome of COVID-19 patients with CKD.