From the Research
For patients with impaired renal function, no dosage adjustments are needed for Anidulafungin and Linezolid, while Ceftolozane/Tazobactam requires adjustment based on the degree of renal impairment. Anidulafungin is primarily eliminated through chemical degradation and does not undergo significant renal excretion, so standard dosing (200 mg loading dose followed by 100 mg daily) can be maintained regardless of kidney function 1, 2. Linezolid also requires no adjustment in renal impairment as it is metabolized through non-renal pathways, with standard dosing of 600 mg every 12 hours, as shown in a study where the total apparent oral clearance of linezolid did not change with renal function 1. However, Ceftolozane/Tazobactam requires specific adjustments:
- for creatinine clearance (CrCl) 30-50 mL/min, reduce to 500 mg/250 mg every 8 hours;
- for CrCl 15-29 mL/min, use 250 mg/125 mg every 8 hours;
- and for end-stage renal disease on hemodialysis, administer 100 mg/50 mg every 8 hours with dosing after hemodialysis on dialysis days, based on the findings that Ceftolozane/Tazobactam is primarily eliminated by the kidneys, making dose adjustment necessary to prevent drug accumulation and potential toxicity in renal impairment 2, 3. These recommendations reflect the pharmacokinetic properties of each medication, prioritizing the prevention of drug accumulation and potential toxicity in renal impairment, while ensuring effective treatment. Key considerations include:
- Monitoring renal function and adjusting Ceftolozane/Tazobactam doses accordingly to minimize the risk of acute kidney injury, as suggested by a study on the frequency of acute kidney injury caused by Tazobactam/Piperacillin in patients with pneumonia and chronic kidney disease 4.
- Being aware of potential side effects, such as myelosuppression and nephrotoxicity, associated with Linezolid, especially in patients with pre-existing renal impairment or those undergoing hemodialysis 5. Overall, these adjustments are crucial to optimize the therapeutic efficacy and safety of these medications in patients with impaired renal function.