ANTIBIOTIC ESSENTIALSEdited by Burke A. Cunha Fourteenth Edition Ebook PDF
ANTIBIOTIC ESSENTIALSEdited by Burke A. Cunha Fourteenth Edition Ebook PDF Hepatic Insufficiency. Antibiotic dosing for patients with hepatic dysfunction is problematic, since there is no hepatic counterpart to the serum creatinine to accurately assess liver function. In practice, antibiotic dosing is based on clinical assessment of the severity of liver disease. For practical purposes, dosing adjustments are usually not required for mild or moderate hepatic insufficiency. For severe hepatic insufficiency, dosing adjustments are usually made for antibiotics with hepatotoxic potential. C. Combined Renal and Hepatic Insufficiency.
There are no good dosing adjustment guidelines for patients with hepatorenal insufficiency. If renal insufficiency is worse than hepatic insufficiency, antibiotics eliminated by the liver are often administered at half the total daily dose. If hepatic insufficiency is more severe than renal insufficiency, renally eliminated antibiotics are usually administered and dosed in proportion to renal function.
D. Mode of Antibiotic and Excretion/Excretory Organ Toxicity. The mode of elimination/ excretion does not predispose to excretory organ toxicity per se, e.g., nafcillin (hepatically eliminated) is not hepatotoxic, and it’s main side effect is nephrotoxicity (interstitial nephritis).
In contrast, oxacillin (renally eliminated), is not nephrotoxic and it’s main side effect is hepatotoxicity (hepatitis).
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