From the Research
Phosphomycin dosing should be adjusted in patients with acute kidney injury (AKI) based on the severity of renal impairment, with the most recent and highest quality study suggesting dose adjustments to prevent toxicity and ensure efficacy 1. When considering the dosing of Phosphomycin in patients with AKI, it is crucial to understand the pharmacokinetic changes that occur in this population.
- The kidneys play a significant role in eliminating Phosphomycin, with approximately 80% excreted unchanged in urine.
- Reduced kidney function can lead to drug accumulation and potentially increased toxicity if doses are not adjusted.
- Monitoring renal function regularly during treatment and adjusting dosing as needed if kidney function changes is essential. Some key points to consider when dosing Phosphomycin in patients with AKI include:
- For patients with mild to moderate AKI (creatinine clearance 20-40 mL/min), the recommended dose may need to be adjusted, but the exact dose is not specified in the provided studies.
- For severe AKI (creatinine clearance <20 mL/min), the dose should be reduced to prevent toxicity.
- Patients on hemodialysis or continuous renal replacement therapy require special consideration, with dosing adjusted based on the type and intensity of renal replacement therapy. It is also important to watch for potential side effects, including:
- Gastrointestinal disturbances
- Electrolyte abnormalities
- Liver enzyme elevations, which may be more common in patients with impaired renal function. The most recent study 1 highlights the importance of considering pharmacokinetic alterations, including changes in absorption, distribution, protein binding, metabolism, and renal elimination, when dosing Phosphomycin in patients with AKI.
- This study emphasizes the need for therapeutic drug monitoring to ensure that patients receive effective and safe doses of Phosphomycin.
- By adjusting Phosphomycin dosing based on the severity of renal impairment and monitoring for potential side effects, clinicians can help improve outcomes for patients with AKI.