Critically Ill Patients with Renal Hyperfiltration: Optimizing Antibiotic Dose

Table 4

Behavior of the pharmacokinetic characteristics of hydrophilic and lipophilic antibiotics in patients in the general ward and in the critical care unit.

	Hydrophilic antibiotics	Lipophilic antibiotics
General ward PK	(1) Low intracellular penetration	(1) High Vd
	(2) Predominant renal CL	(2) Predominant hepatic CL: needs liver metabolism to render them water soluble
	(3) Low Vd	(3) Good intracellular penetration
Altered PK in ICU	(1) ↑ Vd	(1) Vd largely unchanged
	(2) CL ↑ or ↓ dependent on renal function	(2) CL ↑ or ↓ dependent on liver function
Examples	Fluoroquinolones: levofloxacin, ciprofloxacin	Fluoroquinolones: moxifloxacin, gatifloxacin, sparfloxacin, tigecycline, lincosamides, and macrolides
	β-lactams
	Colistin
	Aminoglycosides
	Glycopeptides
	Linezolid: nonhepatic nor renal elimination

PK: pharmacokinetics Vd: volume of distribution. CL: clearance. Modified from Roberts and Lipman [9].