Use of antibiotics in patients with chronic kidney disease: evidence from the real world

BACKGROUND: Most antibiotics require dose adjustments in patients with chronic kidney disease (CKD) to avoid accumulation and toxicity. The aim was to characterize the use of systemic antibiotics in a group of patients with CKD and to adjust the dose according to the glomerular filtration rate (GFR). RESEARCH DESIGN AND METHODS: Observational study of patients with a diagnosis of CKD who received antibiotics between January-2021 July 2022. The Lexicomp® database was used to determine the dose adjustment according to the GFR. RESULTS: A total of 473 patients were included, average age of 72.6 years. Patients with CKD were in stage 3 (38.5%), stage 4 (23.5%), or stage 5 (38.1%). Cephalosporins (56.2%), penicillins (43.3%), and glycopeptides (20.3%) were the most widely used antibiotics. A total of 914 antibiotics were used, of which 39.5% did not require dose adjustment, 30.4% had no dose adjustment, and 30.1% had dose adjustment. Treatment with glycopeptides (adjusted Odds Ratio [aOR]:3.86; 95%CI:1.57-9.47), treatment with carbapenems (aOR:4.59; 95%CI:1.75-12.07), stage-4 CKD (aOR:31.61; 95%CI:9.77-102.29), and stage-5 CKD (aOR:21.29; 95%CI:3.66-123.61) increased the probability of receiving antibiotics without dose adjustment according to the GFR. CONCLUSIONS: Almost one-third of the antibiotics used in this group of patients had no dose adjustment, which generates a significant risk of toxicity and the need to identify CKD in a timely manner and the appropriate use of antibiotics.