Polymyxin acute kidney injury : dosing and other strategies to reduce toxicity
Autor(a) principal: | |
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Data de Publicação: | 2019 |
Outros Autores: | , , |
Tipo de documento: | Artigo |
Idioma: | eng |
Título da fonte: | Repositório Institucional da UFRGS |
Texto Completo: | http://hdl.handle.net/10183/229319 |
Resumo: | Polymyxins are valuable antimicrobials for the management of multidrug-resistant Gram-negative bacteria; however, nephrotoxicity associated with these drugs is a very common side effect that occurs during treatment. This article briefly reviews nephrotoxic mechanisms and risk factors for polymyxin-associated acute kidney injury (AKI) and discusses dosing strategies that may mitigate kidney damage without compromising antimicrobial activity. Polymyxins have a very narrow therapeutic window and patients requiring treatment with these drugs are frequently severely ill and have multiple comorbidities, which increases the risk of AKI. Notably, there is a significant overlap between therapeutic and toxic plasma polymyxin concentrations that substantially complicates dose selection. Recent dosing protocols for both colistin and polymyxin B have been developed and may help fine tune dose adjustment of these antibiotics. Minimizing exposure to modifiable risk factors, such as other nephrotoxic agents, is strongly recommended. The dose should be carefully selected, particularly in high-risk patients. The administration of oxidative stress-reducing drugs is a promising strategy to ameliorate polymyxin-associated AKI, but still requires support from clinical studies. |
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Nation, Roger L.Rigatto, Maria Helena da Silva PitombeiraFalci, Diego RodriguesZavascki, Alexandre Prehn2021-09-01T04:25:12Z20192079-6382http://hdl.handle.net/10183/229319001130281Polymyxins are valuable antimicrobials for the management of multidrug-resistant Gram-negative bacteria; however, nephrotoxicity associated with these drugs is a very common side effect that occurs during treatment. This article briefly reviews nephrotoxic mechanisms and risk factors for polymyxin-associated acute kidney injury (AKI) and discusses dosing strategies that may mitigate kidney damage without compromising antimicrobial activity. Polymyxins have a very narrow therapeutic window and patients requiring treatment with these drugs are frequently severely ill and have multiple comorbidities, which increases the risk of AKI. Notably, there is a significant overlap between therapeutic and toxic plasma polymyxin concentrations that substantially complicates dose selection. Recent dosing protocols for both colistin and polymyxin B have been developed and may help fine tune dose adjustment of these antibiotics. Minimizing exposure to modifiable risk factors, such as other nephrotoxic agents, is strongly recommended. The dose should be carefully selected, particularly in high-risk patients. The administration of oxidative stress-reducing drugs is a promising strategy to ameliorate polymyxin-associated AKI, but still requires support from clinical studies.application/pdfengAntibiotics. Basel. Vol. 8 (2019), 24, 18 p.Injúria renal agudaColistinaAntibacterianosPolimixina BDosagemTratamento farmacológicoFarmacocinéticaFarmacodinâmicaColistinAcute kidney injuryPolymyxin BDosingPharmacokinetics/pharmacodynamicsPolymyxin acute kidney injury : dosing and other strategies to reduce toxicityEstrangeiroinfo:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/openAccessreponame:Repositório Institucional da UFRGSinstname:Universidade Federal do Rio Grande do Sul (UFRGS)instacron:UFRGSTEXT001130281.pdf.txt001130281.pdf.txtExtracted Texttext/plain77853http://www.lume.ufrgs.br/bitstream/10183/229319/2/001130281.pdf.txt4b0726c6ff507378c0281cc6715687daMD52ORIGINAL001130281.pdfTexto completo (inglês)application/pdf538689http://www.lume.ufrgs.br/bitstream/10183/229319/1/001130281.pdfb5f8b28580e607b223f3efbdd2c710c6MD5110183/2293192021-09-19 04:29:40.035349oai:www.lume.ufrgs.br:10183/229319Repositório de PublicaçõesPUBhttps://lume.ufrgs.br/oai/requestopendoar:2021-09-19T07:29:40Repositório Institucional da UFRGS - Universidade Federal do Rio Grande do Sul (UFRGS)false |
dc.title.pt_BR.fl_str_mv |
Polymyxin acute kidney injury : dosing and other strategies to reduce toxicity |
title |
Polymyxin acute kidney injury : dosing and other strategies to reduce toxicity |
spellingShingle |
Polymyxin acute kidney injury : dosing and other strategies to reduce toxicity Nation, Roger L. Injúria renal aguda Colistina Antibacterianos Polimixina B Dosagem Tratamento farmacológico Farmacocinética Farmacodinâmica Colistin Acute kidney injury Polymyxin B Dosing Pharmacokinetics/pharmacodynamics |
title_short |
Polymyxin acute kidney injury : dosing and other strategies to reduce toxicity |
title_full |
Polymyxin acute kidney injury : dosing and other strategies to reduce toxicity |
title_fullStr |
Polymyxin acute kidney injury : dosing and other strategies to reduce toxicity |
title_full_unstemmed |
Polymyxin acute kidney injury : dosing and other strategies to reduce toxicity |
title_sort |
Polymyxin acute kidney injury : dosing and other strategies to reduce toxicity |
author |
Nation, Roger L. |
author_facet |
Nation, Roger L. Rigatto, Maria Helena da Silva Pitombeira Falci, Diego Rodrigues Zavascki, Alexandre Prehn |
author_role |
author |
author2 |
Rigatto, Maria Helena da Silva Pitombeira Falci, Diego Rodrigues Zavascki, Alexandre Prehn |
author2_role |
author author author |
dc.contributor.author.fl_str_mv |
Nation, Roger L. Rigatto, Maria Helena da Silva Pitombeira Falci, Diego Rodrigues Zavascki, Alexandre Prehn |
dc.subject.por.fl_str_mv |
Injúria renal aguda Colistina Antibacterianos Polimixina B Dosagem Tratamento farmacológico Farmacocinética Farmacodinâmica |
topic |
Injúria renal aguda Colistina Antibacterianos Polimixina B Dosagem Tratamento farmacológico Farmacocinética Farmacodinâmica Colistin Acute kidney injury Polymyxin B Dosing Pharmacokinetics/pharmacodynamics |
dc.subject.eng.fl_str_mv |
Colistin Acute kidney injury Polymyxin B Dosing Pharmacokinetics/pharmacodynamics |
description |
Polymyxins are valuable antimicrobials for the management of multidrug-resistant Gram-negative bacteria; however, nephrotoxicity associated with these drugs is a very common side effect that occurs during treatment. This article briefly reviews nephrotoxic mechanisms and risk factors for polymyxin-associated acute kidney injury (AKI) and discusses dosing strategies that may mitigate kidney damage without compromising antimicrobial activity. Polymyxins have a very narrow therapeutic window and patients requiring treatment with these drugs are frequently severely ill and have multiple comorbidities, which increases the risk of AKI. Notably, there is a significant overlap between therapeutic and toxic plasma polymyxin concentrations that substantially complicates dose selection. Recent dosing protocols for both colistin and polymyxin B have been developed and may help fine tune dose adjustment of these antibiotics. Minimizing exposure to modifiable risk factors, such as other nephrotoxic agents, is strongly recommended. The dose should be carefully selected, particularly in high-risk patients. The administration of oxidative stress-reducing drugs is a promising strategy to ameliorate polymyxin-associated AKI, but still requires support from clinical studies. |
publishDate |
2019 |
dc.date.issued.fl_str_mv |
2019 |
dc.date.accessioned.fl_str_mv |
2021-09-01T04:25:12Z |
dc.type.driver.fl_str_mv |
Estrangeiro info:eu-repo/semantics/article |
dc.type.status.fl_str_mv |
info:eu-repo/semantics/publishedVersion |
format |
article |
status_str |
publishedVersion |
dc.identifier.uri.fl_str_mv |
http://hdl.handle.net/10183/229319 |
dc.identifier.issn.pt_BR.fl_str_mv |
2079-6382 |
dc.identifier.nrb.pt_BR.fl_str_mv |
001130281 |
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2079-6382 001130281 |
url |
http://hdl.handle.net/10183/229319 |
dc.language.iso.fl_str_mv |
eng |
language |
eng |
dc.relation.ispartof.pt_BR.fl_str_mv |
Antibiotics. Basel. Vol. 8 (2019), 24, 18 p. |
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info:eu-repo/semantics/openAccess |
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openAccess |
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application/pdf |
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