ArticleAntibiotics (Basel, Switzerland)2022
Steering Away from Current Amoxicillin Dose Reductions in Hospitalized Patients with Impaired Kidney Function to Avoid Subtherapeutic Drug Exposure.
Article in Antibiotics (Basel, Switzerland), 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers.
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Who cites it
4 citing papers in PubMed, 3 citations in OpenAlex.
- Prospective evaluation of imipenem trough concentrations and clinical outcomes in critically ill patients.The Journal of antimicrobial chemotherapy · 2026Observational
- Examining the risk of neurotoxicity in patients who receive unadjusted doses of oral beta-lactams in renal insufficiency: a retrospective cohort study.European journal of clinical pharmacology · 2026Article
- Oral Therapy for Infective Endocarditis: Where Do We Stand?Pathogens (Basel, Switzerland) · 2025Review
- Oral Antibiotics for Bacteremia and Infective Endocarditis: Current Evidence and Future Perspectives.Microorganisms · 2023Review
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Authors and funding
9 authors at 4 institutions in 4 countries.
Funding
Abstract
Current dose reductions recommended for amoxicillin in patients with impaired kidney function could lead to suboptimal treatments. In a prospective, observational study in hospitalized adults with varying kidney function treated with an IV or oral dose of amoxicillin, amoxicillin concentrations were measured in 1−2 samples on the second day of treatment. Pharmacometric modelling and simulations were performed to evaluate the probability of target attainment (PTA) for 40% of the time above MIC following standard (1000 mg q6h), reduced or increased IV dosing strategies. A total of 210 amoxicillin samples was collected from 155 patients with kidney function based on a CKD-EPI of between 12 and 165 mL/min/1.73 m2. Amoxicillin clearance could be well predicted with body weight and CKD-EPI. Recommended dose adjustments resulted in a clinically relevant reduction in the PTA for the nonspecies-related PK/PD breakpoint MIC of 8 mg/L (92%, 62% and 38% with a CKD-EPI of 10, 20 and 30 mL/min/1.73 m2, respectively, versus 100% for the standard dose). For MICs ≤ 2 mg/L, PTA > 90% was reached in these patients following both reduced and standard dose regimens. Our study showed that for amoxicillin, recommended dose reductions with impaired kidney function could lead to subtherapeutic amoxicillin concentrations in hospitalized patients, especially when targeting less susceptible pathogens.
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